Sat, 25 May 2019 07:54:59 -0700WeeblyThu, 12 Jul 2018 15:23:55 GMThttp://www.medicineandreligion.com/july-blog---muhammad-fareed-md/dying-with-dignity-a-muslim-perspectiveIf the heart knew the secret of life as it is,It would also know the Divine Mysteries at deathToday when with thy self, thou knowest nothing,Tomorrow when stripped of self, what wilt thou know?

This translated quatrain from Omar Khayyam’s original work in Persian (1859) alludes to one of the most important tenets of Islamic eschatology: “the soul”. While it can both perceive and execute in this world, the soul renounces itself from acting and knowing and carries with it only the fruit of its ventures and the insight which it has attained of spiritual matters on its alluvial journey of death. What makes death unique is its metaphorical aspect as perceived by Muslims in apprehending death as the transition point or journey between two segments of a continuous life, existent and future. For Muslims, death offers the rationale for living on this earth.

Islam brought with it a shift in philosophy of death away from focusing on time in the here-and-now to a focus on our eternal abode. It discourages patients from being controlled by “fear” of death by emphasizing how time spent in this world should be focused on good deeds that would be rewarded with eternal life. Fate, time and “the days” were central themes in a person’s life. Arabs in the pre-Islamic world are quoted in the Quran as believing: “There is nothing but our life in this world. We live and we die and nothing destroys us but Time” (45:24). In contrast, Muhammad (PBUH) is adjured to say: “It is God who gives you life, causes you to die, then gathers you together for the Day of Resurrection, of which there is no doubt” (45:26).

Shariah Law is based on the Quran and Hadith (the practices and sayings of the Prophet Muhammad), which define certain expectations at the time of death being universally practiced by Muslims. The dying Muslim contemplates visits by relatives and friends. They are to pray for the sick person’s welfare in the coming life. The sick person is also to seek pardon from those they may have harmed. Visitors of the sick should offer their pardon to relieve the patient. Relatives and friends encourage a dying Muslim to repeat his faith, Shahadah - “There is no God but Allah and Muhammad is his messenger.” Ideally, the dying person will have asked for God and people’s forgiveness, prepared a will, performed the ritual of full-body ceremonial washing before prayer, and recited the Shahadah before death.

After death, the corpse is treated with great respect, the eyes and mouth are closed and the limbs straightened. The body is then washed, wrapped in a shroud consisting of three pieces of clean, white, seamless cloth. There is a special funeral prayer for the deceased, which is unique because the congregation remains standing, rather than the normal posture of prostration during daily prayers. The corpse is then buried, ideally within twenty-four hours of death and without a coffin. A grave is dug deep enough to cover the body that should lie on its right side with the head facing in the direction of Mecca. The grave is then filled in with earth, resulting in a heap above the ground level. A simple headstone may be erected to mark the grave.

In order to further substantiate these practices, our research team explored the concept of a good death among contemporary Muslim patients and health care providers (1). We interviewed 284 patients and caregivers in Saudi Arabia, and we found that there were especially three critical areas of a good death in the Muslim perspective that is widely held.

1. Religious faith and beliefs: One component is related to making sure that somebody is there to prompt a dying person with Shahadah and to recite from Quran, to be in a position facing Makkah and to die in a holy place (e.g., Madinah, Makkah, or mosque) or in a holy time (e.g., in Ramadan or on a Friday), although they have no control over last two aspects.

2. Self-esteem and body image: A second component includes principles related to the patient's self-esteem and image in his friends and relatives' eyes by avoiding post-mortem distortions, deformities, septic wounds or bad odors by maintaining continence and keeping the body and clothes free of urine, stool and vomit.

3. Concerns about family security: The third domain is related to the patient's satisfaction about his family’s security and good future. This relates primarily to economic and social concerns after the death. Readers may note that the patient and his family are referred to as a single unit, which can be contrasted with an emphasis on patient autonomy and self-determination. This could be attributed to the distinct nature of the Muslim family and its composite interrelations and strong ties.

While working in Tabuk, Saudi Arabia, I was paged by the nursing staff at around 11 PM, for increasing agitation and respiratory difficulty experienced by a dying patient for supportive care. He was having death rattles at the time of his examination. It was obviously distressing to the patient’s wife and three sons. At this time, they encouraged the patient to recite the Quran at his bedside as death approached. I called the attending who counselled the family that the death rattles do not cause discomfort for the dying person and he also encouraged the family to recite verses from Quran. The patient was also administered Haloperidol for agitation. He was given cleansing and ablution by his sons with Shahdah recitation. The patient passed away in the early morning hours while his face was facing towards Makkah. The usual customs of washing, wrapping in a shroud and burial were then carried out in quick succession.​Several aspects of a “good death” as perceived by some in the West, are not recognized as being paramount by many Muslim patients or health care providers. It is important that within medical education, clinicians learn how different cultures and religions shape the meaning of a good dying. The Islamic perspective of a “good death” ought to be introduced in health care services, professional codes, and health organizations and institutions. As Western medicine encounters increasing cultural and religious diversity in patient care, on-going educational steps are necessary to develop end-of-life care practices in a Muslim-sensitive manner.